Welcome to the October 2017 issue of Bariatric Times, which also is our special American College of Surgeons edition. For this issue, we interviewed John Morton, MD, FACS, FASMBS, Past President of the American Society of Metabolic and Bariatric Surgery (ASMBS) and current Chair of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). Dr. Morton describes the current status of the MBSAQIP quality and improvement program, of which the national bariatric surgery patient database is a major component. I recently presented data from Cleveland Clinic’s bariatric surgery program (Weston, Florida), which was based on close to 2,400 patients we’ve entered into MBSAQIP over the years. When I compared our data to the national numbers in MBSAQIP, I was impressed to see that there were over 900,000 patients entered into the national database—patients that are followed by the 831 MBSAQIP-accredited bariatric programs. Clinicians and researchers alike should take advantage of the vast amount of information this database contains, and use it as a tool to better understand how their own clinics perform, including re-interventions and readmissions, so that they might continually improve their bariatric surgery program and achieve optimal patient safety, satisfaction, and health.

In this issue, I also respond to a letter to the editor by Dr. Metz, who shares his perspective on the challenges we, as bariatric surgeons in the United States, often face when patients who have undergone bariartic surgery in other countries present to our emergency room or clinic with complications. “Medical tourism” is a important and complex issue that warrants careful attention from the bariatric surgeon community, particularly in the United States, where insurance companies refuse coverage of complications for patients who had their bariatric surgery performed in another country.

I’d also like to call to your attention to an article we are featuring this month on vertical banded gastroplasty (VBG). Here, Drs. Kamel, Yorke, and DeGara present their own experience managing gastric outlet obstruction (GOO) in patients who’ve undergone VBG. VBG is a procedure bariatric surgeons no longer offer as a treatment option due to its rate of complications. Yet, we continue to treat patients who underwent this procedure, because over 30 percent of them develop complications related to the staple line. In these cases, the staple line will dehisce, resulting in weight regain. The pre-anastomotic ring (PAR) can also create GOO and gastroesophageal reflux disease (GERD). While removing the PAR is an option that will certainly relieve the GOO and GERD, it will not address the weight regain and disease recurrence.

And finally, my co-editor for the Allied Health section of the journal, Tracy Martinez, RN, BSN, introduces us to Erik Sudin, who is an MD candidate, and Faha Zubahr, MD. These authors present us with an excellent review on the fascinating subject of the gut microbiome. I recently attended a presentation on the microbiome by Eiran Elinav, MD, PhD, who is working in conjunction with the Weitzman Institute in Israel and the Howard Huges Medical Institute in Chevy Chase, Maryland, and I was stunned—to say the least—to learn about the potential impact our gut flora have on the obesity disease. It appears that the bacteria that colonize our gastrointestinal tract from an early age might be responsible for triggering appetite as well as stimulating certain receptors that result in our preference for certain types of foods, which might then result in a higher incidence of obesity. The article by Sudin and Zubahr is accredited for 1.5 continuing education units in nursing.

I hope you enjoy the issue. I look forward to seeing many of you at Clinical Congress 2017, which is the annual ACS conference, to be held October 22–26 in Washington, D.C.

Sincerely,

Raul J. Rosenthal, MD, FACS, FASMBS

Reference

Rosenthal RJ, editor. American College of Surgeons Quality and Safety Conference; 2017 July 21-24; New York, NY.

History of Bariatric Surgery

by Jacques Himpens, MD, PhD Watch the Video: Robotic Laparoscopic Cholecystectomy Jacques Himpens, MD, PhD, is an Associate Professor of Surgery at the European School of Laparoscopic Surgery and Chief of Bariatric Surgery at the CHIREC Hospital, Brussels, Belgium, and St. Blasius General Hospital, Dendermonde, Belgium. In 1977, he graduated cum laude from the Catholic […]

by Rafael F. Capella, MD, FACS Dr. Rafael F. Capella was a Clinical Assistant Professor of Surgery at the New Jersey Medical School of Newark, New Jersey, and a founding member of the American Society for Bariatric Surgery. He was a director of the Division of Bariatric Surgery at Hackensack University Medical Center at Hackensack, […]

by John G. Kral, MA, MD, PhD, FACS Professor of Surgery, Medicine and Cell Biology, SUNY Downstate Medical Center, College of Medicine and School of Graduate Studies, Brooklyn, New York. Dr. Kral is Professor of Surgery, Medicine and Cell Biology and former Director of Surgery at Kings County Hospital, Brooklyn, New York. He is past […]

Dr. Ricardo Cohen is the Director of The Center for Obesity and Diabetes at Oswaldo Cruz German Hospital in Sao Paulo, Brazil. He is also former President of the Brazilian Society for Bariatric and Metabolic Surgery. Dr. Cohen is a member of the Editorial Board for Surgery for Obesity and Related Diseases, Advisory Editor for […]

by Paul O’Brien, MD, FRAS Dr. Paul O’Brien is the head of the Centre for Bariatric Surgery in Melbourne, Australia, and Emeritus Professor of Surgery at Monash University. He was Head of the University’s Department of Surgery at the Alfred Hospital from 1986 to 2004. He founded the Centre for Obesity Research and Education (CORE) […]